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Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020

BACKGROUND: Availability of SARS-CoV-2 testing in the United States (U.S.) has fluctuated through the course of the COVID-19 pandemic, including in the U.S. state of Illinois. Despite substantial ramp-up in test volume, access to SARS-CoV-2 testing remains limited, heterogeneous, and insufficient to...

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Autores principales: Holden, Tobias M., Richardson, Reese A. K., Arevalo, Philip, Duffus, Wayne A., Runge, Manuela, Whitney, Elena, Wise, Leslie, Ezike, Ngozi O., Patrick, Sarah, Cobey, Sarah, Gerardin, Jaline
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189821/
https://www.ncbi.nlm.nih.gov/pubmed/34107947
http://dx.doi.org/10.1186/s12889-021-11177-x
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author Holden, Tobias M.
Richardson, Reese A. K.
Arevalo, Philip
Duffus, Wayne A.
Runge, Manuela
Whitney, Elena
Wise, Leslie
Ezike, Ngozi O.
Patrick, Sarah
Cobey, Sarah
Gerardin, Jaline
author_facet Holden, Tobias M.
Richardson, Reese A. K.
Arevalo, Philip
Duffus, Wayne A.
Runge, Manuela
Whitney, Elena
Wise, Leslie
Ezike, Ngozi O.
Patrick, Sarah
Cobey, Sarah
Gerardin, Jaline
author_sort Holden, Tobias M.
collection PubMed
description BACKGROUND: Availability of SARS-CoV-2 testing in the United States (U.S.) has fluctuated through the course of the COVID-19 pandemic, including in the U.S. state of Illinois. Despite substantial ramp-up in test volume, access to SARS-CoV-2 testing remains limited, heterogeneous, and insufficient to control spread. METHODS: We compared SARS-CoV-2 testing rates across geographic regions, over time, and by demographic characteristics (i.e., age and racial/ethnic groups) in Illinois during March through December 2020. We compared age-matched case fatality ratios and infection fatality ratios through time to estimate the fraction of SARS-CoV-2 infections that have been detected through diagnostic testing. RESULTS: By the end of 2020, initial geographic differences in testing rates had closed substantially. Case fatality ratios were higher in non-Hispanic Black and Hispanic/Latino populations in Illinois relative to non-Hispanic White populations, suggesting that tests were insufficient to accurately capture the true burden of COVID-19 disease in the minority populations during the initial epidemic wave. While testing disparities decreased during 2020, Hispanic/Latino populations consistently remained the least tested at 1.87 tests per 1000 population per day compared with 2.58 and 2.87 for non-Hispanic Black and non-Hispanic White populations, respectively, at the end of 2020. Despite a large expansion in testing since the beginning of the first wave of the epidemic, we estimated that over half (50–80%) of all SARS-CoV-2 infections were not detected by diagnostic testing and continued to evade surveillance. CONCLUSIONS: Systematic methods for identifying relatively under-tested geographic regions and demographic groups may enable policymakers to regularly monitor and evaluate the shifting landscape of diagnostic testing, allowing officials to prioritize allocation of testing resources to reduce disparities in COVID-19 burden and eventually reduce SARS-CoV-2 transmission. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-021-11177-x.
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spelling pubmed-81898212021-06-10 Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020 Holden, Tobias M. Richardson, Reese A. K. Arevalo, Philip Duffus, Wayne A. Runge, Manuela Whitney, Elena Wise, Leslie Ezike, Ngozi O. Patrick, Sarah Cobey, Sarah Gerardin, Jaline BMC Public Health Research BACKGROUND: Availability of SARS-CoV-2 testing in the United States (U.S.) has fluctuated through the course of the COVID-19 pandemic, including in the U.S. state of Illinois. Despite substantial ramp-up in test volume, access to SARS-CoV-2 testing remains limited, heterogeneous, and insufficient to control spread. METHODS: We compared SARS-CoV-2 testing rates across geographic regions, over time, and by demographic characteristics (i.e., age and racial/ethnic groups) in Illinois during March through December 2020. We compared age-matched case fatality ratios and infection fatality ratios through time to estimate the fraction of SARS-CoV-2 infections that have been detected through diagnostic testing. RESULTS: By the end of 2020, initial geographic differences in testing rates had closed substantially. Case fatality ratios were higher in non-Hispanic Black and Hispanic/Latino populations in Illinois relative to non-Hispanic White populations, suggesting that tests were insufficient to accurately capture the true burden of COVID-19 disease in the minority populations during the initial epidemic wave. While testing disparities decreased during 2020, Hispanic/Latino populations consistently remained the least tested at 1.87 tests per 1000 population per day compared with 2.58 and 2.87 for non-Hispanic Black and non-Hispanic White populations, respectively, at the end of 2020. Despite a large expansion in testing since the beginning of the first wave of the epidemic, we estimated that over half (50–80%) of all SARS-CoV-2 infections were not detected by diagnostic testing and continued to evade surveillance. CONCLUSIONS: Systematic methods for identifying relatively under-tested geographic regions and demographic groups may enable policymakers to regularly monitor and evaluate the shifting landscape of diagnostic testing, allowing officials to prioritize allocation of testing resources to reduce disparities in COVID-19 burden and eventually reduce SARS-CoV-2 transmission. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-021-11177-x. BioMed Central 2021-06-10 /pmc/articles/PMC8189821/ /pubmed/34107947 http://dx.doi.org/10.1186/s12889-021-11177-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Holden, Tobias M.
Richardson, Reese A. K.
Arevalo, Philip
Duffus, Wayne A.
Runge, Manuela
Whitney, Elena
Wise, Leslie
Ezike, Ngozi O.
Patrick, Sarah
Cobey, Sarah
Gerardin, Jaline
Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020
title Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020
title_full Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020
title_fullStr Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020
title_full_unstemmed Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020
title_short Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020
title_sort geographic and demographic heterogeneity of sars-cov-2 diagnostic testing in illinois, usa, march to december 2020
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189821/
https://www.ncbi.nlm.nih.gov/pubmed/34107947
http://dx.doi.org/10.1186/s12889-021-11177-x
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